Medicaid may expand, but will doctors see anybody?

A rapid expansion of Medicaid in Colorado depends on a bunch of factors, from interpretation of the Supreme Court to building a better computer system. But it will also rest on the willingness of doctors to take hundreds of thousands of new patients, at rates many claim are so low they can’t make any money.

A new study in Health Affairs, detailed in Kaiser Health News, says that in Colorado, slightly less than the national average of doctors agree to take on new patients who are on low-paying Medicaid. The Colorado rate is about 66 percent, just under the national average of 69 percent.

States reported a wide range of doctor willingness to take Medicaid. In New Jersey, only 40 percent of doctors will take on new Medicaid patients, while in Wyoming, 99 percent will.

Health care reform could improve the payment rates, but to treat the large volume of newly insured Coloradans in 2014, community health systems will have to be creative about using other professionals. Those will include nurse practitioners, physician assistants, nurses with various specialties, and a more standardized approach to treating low-income patients in the way that Denver Health and other centers have pioneered.

Colorado policymakers, meanwhile, await word from the state Medicaid office and the governor, on how enthusiastic they will be about expanding the program to more adults without dependent children. That’s the key group meant to be addressed in health reform, but Republican and other small-government opponents have said the expansion will eventually cost states too much money. Gov. John Hickenlooper has said he awaits a thorough number-crunching from state Medicaid estimators before he decides whether to join, or take the Supreme Court’s newly opened back door out of the dilemma.

Electa Draper is the health writer for The Denver Post and has covered every news beat in a 22-year journalism career at three newspapers. She has a bachelor's degree in biology and a master's in journalism.